El primer caso de infección humana por SARS-CoV2 se registró en Wuhan, China, en noviembre de 2019; a partir de entonces ha tenido una diseminación mundial y está afectando a seres humanos de todas las edades. La pandemia por COVID-19, causada por SARS-CoV-2, desencadenó una catástrofe en todos los sistemas de salud. Mucho hay aún por entender como clínicos, epidemiólogos e investigadores que hemos estado trabajando en describir y caracterizar el proceso de la enfermedad mientras estamos atendiendo a los pacientes en las trincheras.El propósito de este artículo de revisión es conocer los datos clínicos generados en los últimos cuatro meses en relación con el comportamiento de COVID-19 y describir las manifestaciones de la enfermedad en la población pediátrica.

The first case of human infection with SARS-CoV-2 was in Wuhan China in November 2019 and from that moment has had a spread in all the world affecting people of any age. The COVID-19 pandemic caused by SARS-CoV-2 has represented a catastrophe in the health systems of the world. Much remains to be understood like physicians, epidemiologists. researches have been seeing patients in the trenches. The purpose of this review article is to know the clinical data generated in the last four months in relation to the behavior of COVID-19, as well as to describe the manifestations of the disease in the pediatric population.

INTRODUCTION Septic shock is one of the main causes of mortality. Fluid replacement stands out as the treatment of choice to reduce mortality. OBJECTIVE To determine the relation between the percentage of fluid overload (%FO) and mortality in children with septic shock. METHODS Cohort study in patients aged 1-17 years with septic shock, after fluid replacement with central venous pressure ≥ 5 mmHg, invasive monitoring, and complete recording of %FO up to 96 h. Follow-up and outcome measures were recorded up to day 28. The following outcome measures of septic shock were recorded: refractory shock, cause of acute kidney injury, anemia, malnutrition, time to antibiotic initiation, oncotic pressure, and severity score. STATISTICAL ANALYSIS AND METHODS The hazard ratio (HR) was estimated and three Cox proportional hazard models were developed. RESULTS The population included 263 patients; their average age was 8 ± 3 years. Mortality was 33 %. A %FO ≥ 10.1 % accumulated at 96 h was the only associated outcome measure; the HR (95 % confidence interval) was adjusted for hemodynamic profile, HR = 2.6 (1.95.6); refractory shock, HR = 2.5 (1.6-5.6); and malnutrition, HR = 8.3 (3.5-14). CONCLUSIONS A %FO > 10.1 % was related to a higher mortality at 28 days of adjustment for hemodynamic profile, refractory shock, and nutritional status.

BackgroundKawasaki disease shock syndrome (KDSS) is an uncommon presentation of Kawasaki disease (KD). KDSS has been associated with more severe markers of inflammation, coronary abnormalities and i.v. immunoglobulin (IVIG) resistance. MethodsA retrospective, descriptive study of children with KDSS in two hospitals was performed. Relevant articles about KD and shock were collected, and demographic data, clinical presentation, laboratory variables, echocardiogram findings, treatment and special features were analyzed when available. Twelve patients diagnosed with KDSS were retrospectively reviewed from two centers in Mexico, along with 91 additional cases from the literature. ResultsSeventy-two patients presented with complete KD (69.9%), and 30.1% (31/103) had unusual KD manifestations. The most frequent diagnosis at the time of admission was toxic shock syndrome (TSS; n = 20). Sixteen of the 20 had coronary artery abnormalities. Overall, abnormalities in the coronary arteries were documented in 65% of the patients. The mortality rate was 6.8%. ConclusionThe presence of coronary aneurysms was significantly and positively correlated with male gender, IVIG resistance, inotrope treatment, cardiac failure, abdominal pain and neurological symptoms. IVIG-resistant patients had higher neutrophil : lymphocyte ratio. Abdominal symptoms, hypoalbuminemia and elevated C-reactive protein were present in almost all of the patients. Multisystem involvement with atypical presentation in KDSS is frequent. An important differential diagnosis is TSS. Mechanical ventilation, gastrointestinal and neurological symptoms were associated with IVIG resistance and the presence of coronary aneurysms. The first line of treatment includes IVIG and pulse corticosteroids; in severe cases, infliximab, anakinra, cyclosporine or plasmapheresis are alternative treatment options.

The golden rules have diagnostic utility in acid-base imbalances, especially to differentiate be- tween a mix of conditions, ie when there are acid-base alterations of different origin in the same patient. The first rule is useful for the diagnosis of respiratory disorders, the second for diagnosing metabolic and the third establishes treatment. In this paper we explain the three golden rules of bicarbonate, and how to apply them with some examples.

The interpretation acid base status is key in medical practice. Primary disorders are acidemia or alkalemia; and their metabolic or respiratory components are detected via the arterial blood gases. However, evaluation is limited exclusively to baking and arterial pressure of carbon dioxide. For this purpose, various formulas have been created based on the principle of electroneutrality complement information and detailed di- agnosis. In this paper explains in detail the construction, display and interpretation of the different equations.

INTRODUCTION:Prognostic scales or scores are useful for physicians who work in neonatal intensive care units. There are several validated neonatal scores but they are mostly applicable to low birth weight infants. The aim of this study was to develop and validate a mortality prognostic score in newborn infants, that would include new prognostic outcome measures.POPULATION AND METHODS:The study was conducted in a mother and child hospital in the city of Mexico, part of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). In the first phase of the study, a nested case-control study was designed (newborn infants admitted on the basis of severity criteria during the first day of life), in which a scale was identified and developed with gradual parameters of cumulative score consisting of nine independent outcome measures to predict death, as follows: weight, metabolic acidemia, lactate, PaO2/FiO2, p(A-a) O2, A/a, platelets and serum glucose.Validation was performed in a matched prospective cohort, using 7-day mortality as an endpoint.RESULTS:The initial cohort consisted of 424 newborn infants. Twenty-two cases and 132 controls were selected; and 9 outcome measures were identified, making up the scale named neonatal mortality score-9 Mexico. The validation cohort consisted of 227 newborn infants. Forty-four (19%) deaths were recorded, with an area under the curve (AUC) of 0.92. With a score between 16 and 18, an 85 (11-102) hazard ratio, 99% specificity, 71% positive predictive value and 90% negative predictive value were reported. Conclusions .The proposed scale is a reliable tool to predict severity in newborn infants.

Neutropenic enterocolitis (NEC) is a disease characterized by an inflammatory process with damage to the intestinal mucosa and occurs as a complication of cytotoxic chemotherapy in oncological diseases, and severe neutropenia secondary to other diseases.Objective: To describe the population of patients with NEC who are served in the pediatric intensive care unit at Instituto Nacional de Pediatria.Methods: 10-year data of patients registered with a diagnosis of NEC (1 500 cel/mu L less neutropenia, acute abdomen, consistent studies cabinet) on admission to the intensive therapy that consisted of: age, type of cancer, organ failure, stage of sepsis, medical treatment and surgical management. Frequencies and percentages for qualitative; statistical analysis for measures of dispersion and central tendency were used for quantitative variables.Results: Population of 116 patients, 69 (60%) were men. The leukemia is the most common malignancy in 55%. 35% of patients corresponded to stage school. Sepsis was the most common presentation. Abdominal pain symptom most frequently found. 33% died as a result.Conclusions: The present study is exploratory in nature and compares the local epidemiology of the Instituto Nacional de Pediatria with UTIP world.

BACKGROUND:The sick neonate is susceptible to uncontrolled hyperglycemia by several factors. Our objective was to determine the mortality-predictive role of hyperglycemia in critically ill neonates.METHODS:A cohort study was conducted in neonates admitted during the first hour of life in the intensive care unit. Prenatal and perinatal variables were recorded including ventilatory management, comorbidities, arterial blood gas, blood chemistry and blood count. Serum glucose greater than or equal to 126 mg/dL and greater than or equal to 180 mg/dL was considered consistent with hyperglycemia in neonates born at term and preterm infants, respectively. The children were followed until discharge from the unit. Measures of central tendency and dispersion for quantitative variables and frequencies for qualitative variables were obtained, as well as Kaplan-Meier curves. Association test using the chi-square test for exposed and non-exposed groups and Cox regression analysis was performed and risk calculation was made using the hazard ratio.RESULTS:Out of 146 patients, 16 died (10.7 %). Most common causes were respiratory distress syndrome, perinatal asphyxia, meconium aspiration and sepsis. Association was found between hyperglycemia and chest compression, metabolic acidemia, hyperlactatemia, mechanical ventilatory support, intraventricular hemorrhage and death.CONCLUSIONS:Hyperglycemia was an independent risk factor for the prediction of death, with a likelihood of death of 56.8 % when it was present.

Background: Neutropenic enterocolitis is a complication manifested in cancer patients with neutropenia usually with absolute neutrophils counts of less than 500 cells/mm3. NEC clinically presents as acute abdomen and systemic inflammatory response syndrome. Up to 40 % of cases occur in patients with leukemia. There are few studied risk factors associated with mortality.Objective: To determine independent risk factors associated with mortality in patients with acute lymphoblastic leukemia and neutropenic enterocolitis.Methods: A nested case control study in a cohort of patients with neutropenic enterocolitis admitted to the pediatric intensive care unit of "Instituto Nacional de Pediatria" aged between one month and 17 years old. Cases were defined as subjects with acute lymphoblastic leukemia who were admitted to the pediatric intensive care unit and died from complications of neutropenic enterocolitis. Controls consisted in living patients with acute lymphoblastic leukemia who were admitted to the pediatric intensive care unit because of neutropenic enterocolitis and survived, two controls for sex and age were selected; 22 cases and 44 controls were obtained. Considered risk variables were: chemotherapy phase, type of chemotherapy, presence of organ failure, severity of sepsis and surgical management. Our statistical analysis consists in description of demographic variables, Fisher exact test for quantitative data and Mann-Whitney U test for qualitative data. Risk analysis identified significant differences between the groups. Cox proportional risk analysis and Kaplan Meier graphs were done to express relative risk for mortality and survival differences respectively.Results: Most independent variables were: multiorgan dysfunction with relative risk of 57 (95% CI 6.6-75; p < 0.001); septic shock with relative risk of 15 (CI 95% 2-56; p = 0.008), etoposide use with relative risk of 2.6 (95% CI 1-6.6; p = 0.01) and gastrointestinal bleeding with relative risk of 2.1 (95% CI 1.1-5.5; p = 0.05).Conclusions: In a prospective cohort of patients with leukemia, who developed neutropenic enterocolitis, the variables most associated with mortality were multiorgan dysfunction and gastrointestinal bleeding.

Antecedentes: la enterocolitis neutropénica es una complicación que se manifiesta usualmente en pacientes con cáncer y neutropenia menor a 500 células/mm3; se manifiesta con datos de respuesta inflamatoria sistémica y abdomen agudo. Se encuentra en hasta 40% de los pacientes con leucemia. Existen pocos estudios de factores de riesgo asociados con su mortalidad. Objetivo: determinar factores de riesgo independientes para morta- lidad en pacientes con leucemia linfoblástica aguda y enterocolitis neutropénica. Métodos: estudio de casos y controles anidado en una cohorte de pacientes con enterocolitis neutropénica que ingresaron a la unidad de cuidados intensivos pediátricos del Instituto Nacional de Pediatría con edades entre un mes y 17 años. Se consideraron como casos a los pacientes con leucemia fallecidos por complicaciones por enterocolitis neutropénica y se seleccionaron dos controles pareados por sexo y edad, definidos como pacientes con leucemia y enterocolitis neutro- pénica que sobrevivieron; así se obtuvieron 22 casos y 44 controles. Se registraron como variables de interés: fase de quimioterapia, tipo de quimioterapia, insuficiencia orgánica, presencia y gravedad de sepsis y manejo quirúrgico. Para el análisis se utilizó estadística descriptiva con medidas de tenden- cia central y de dispersión. Las variables cualitativas se compararon con prueba exacta de Fisher y las cuantitativas con U de Mann Whitney. Se calcularon riesgos relativos y se corrió un análisis de riesgos proporcio- nales de Cox. Las diferencias significativas se representaron mediante curvas de Kaplan-Meier. El programa estadístico empleado fue el SPSS versión 16 para Windows. Resultados: las variables más independientes fueron choque séptico con riesgo relativo de 15 (IC 95%: 2-56; p = 0.008), disfunción multiorgánica con riesgo relativo de 57 (IC 95%: 6.6-75; p < 0.0001), sangrado de tubo digestivo con riesgo relativo de 2.3 (IC 95%: 1.1-5.5; p = 0.05), antecedente de uso de etopósido con riesgo relativo de 2.6 (IC 95%: 1-6; p = 0.01). Conclusiones: en una cohorte de pacientes con leucemia complicada con enterocolitis neutropénica las variables más asociadas con mortali- dad fueron la disfunción multiorgánica y el sangrado de tubo digestivo.

El neonato enfermo es susceptible al descontrol de la glucosa por varios factores. Nuestro objetivo fue determinar el papel predictor de mortalidad de la hiperglucemia en neonatos criticamente enfermos. Metodos: se realizo un estudio de cohorte en neonatos que durante la primera hora de vida ingresaron a cuidados intensivos. Se registraron variables prenatales, perinatales, manejo ventilatorio, comorbilidades, gasometria arterial, quimica sanguinea y biometria hematica. Se considero que la glucosa serica ≥ 126 y ≥ 180 mg/dL indicaba hiperglucemia en los neonatos a termino y en los pretermino, respectivamente. Se realizo seguimiento hasta el egreso de la unidad. Se obtuvieron medidas de dispersion y de tendencia central para las variables cuantitativas y frecuencias para las cualitativas, asi como curvas de Kaplan-Meier. Se realizo prueba de asociacion por 2 para los grupos expuestos y no expuestos, analisis de regresion de Cox y calculo de riesgo por hazard ratio. Resultados: de 146 pacientes, fallecieron 16 (10.7 %). Las principales causas fueron sindrome de dificultad respiratoria, asfixia perinatal, aspiracion de meconio y sepsis. Se encontro asociacion entre hiperglucemia y compresion toracica, acidemia metabolica, hiperlactatemia, asistencia mecanica ventilatoria, hemorragia intraventricular y muerte. Conclusiones: la hiperglucemia fue un factor de riesgo independiente para predecir muerte, con probabilidad de muerte de 56.8 % cuando se encontro presente